What is Endophthalmitis?
This is an inflammation of the internal areas of the eye. It is at times the complication of any surgeries that are intraocular, especially cataract surgery.
Endophthalmitis has the possibility of vision loss and the loss of the eye itself. Inflammation of this type can be caused by various fungi as well as bacterial infections.
Other causes can consist of any trauma that is penetrating or any foreign bodies in the intraocular tissue or fluid.
Endophthalmitis Symptoms
This condition normally triggers suddenly a vision decrease, pain as well as redness of the eye. Other symptoms can include:
- Sensitivity to light
- Headache
- Per ocular inflammation
But in some in cases there can be little redness or pain.
Postoperative enophthalmitis develops within a few days of the surgery. At other times, some organisms can develop slowly causing low-grade, chronic inflammation or triggering the infection months after surgery. In these cases the individual can have symptoms or a fever that is related to the source of the infection somewhere else in the body.
Endophthalmitis Causes
The most common cause of endophthalmitis is by direct injection of bacteria or fungus, during eye surgery. All surgery consists of sterile technique but in any surgery it is almost impossible to totally eradicate the risk of infections – this is true no matter what type surgery is being performed. In the majority of cases, the bacteria or microorganism is just part of the normal flora that lives on the eyelids. The most common eye surgery done in the United States is cataract surgery and these have anywhere from a 0.1% to 0.3% chance of infection.
The more common organisms that cause infections are:
- Staphylococcus epidermidis
- Staphylococcus aureus
- Streptococcus bacteria
The infection can be caused from any surgery that is penetrating, and can include injections of medications into the intraocular regions of the eye.
Another cause of this inflammation can be due to trauma. When the eye is ruptured in any way there is a hazard that bacteria will enter the eye and develop into an infection. The risk is even bigger when a foreign object is introduced into the eye, for instance stone, wood, and metal or dirt. Especially in these cases any delay in seeking treatment increases the hazard of developing endophthalmitis. In trauma cases the common organisms include:
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- Bacillus cereus
- Staphylococcus
- Streptococcus
- Pseudomonas
- Escherichia coli
- Enterococcus
Less common are infections that the blood system has carried to the eye from other areas of the body. Common sources in these cases include:
- Wounds that are infected
- Catheter dwelling sites
- Endocarditis
- Intravenous drug use
Endophthalmitis Treatment
There is actually no way to evade this condition. All surgery or injections done ocular are performed with sterile techniques, including rinsing of the periocular skin with betadine, conjunctive as well as the eyelashes. Often individuals with eyelash inflammation that are severe may be advised to use eyelid scrubs for time leading up to surgery. It is vital to follow your physician’s advice about using drops that are antibiotic prior to and especially after surgery.
The therapy for endophthalmitis consists of injections of antibiotics inside the eye. This treatment involves the numbing of the eye and sterile preparing the eye. Then the physician with a very tiny needle will extract fluid out of the eye. This is the fluid that will be used for testing purposes. At this point the physician will normally inject 2 very strong antibiotics:
- One against gram negative bacteria
- One against gram positive bacteria
Most commonly used are ceftazidime and vancomycin. When a fungus is believed to be involved then an injection of amphotericin will be used. There are also physicians who will use an injection of steroids in the eye. Additionally there are other treatments which involve:
- Fortified and very strong antibiotic drops each hour
- Intravenous or oral antibiotics
- Drops of steroids
- Dilating drops for comfort
Frequently individuals will be admitted to the hospital, and outpatients will be followed daily for quite some time. When the endophthalmitis is from another area in the body, the infection source needs to be established and also treated.
For those who only have light perception visual acuity remaining, it should be considered if Vitrectomy surgery is necessary.
The eye doctors will need to follow the individual daily for 2 to 3 days. Then visits may slowly be spaced out especially when it is seen that the infection is decreasing. Most individuals will notice that their vision get substantially better, but not as good as it was before the infection started.
The prognosis for recovery visually will vary. Individuals who have contacted the physician early and have organisms that are less virulent do very well. Individuals with organisms that are very virulent or have an injury that is traumatic may have problems regaining much vision. No matter what the case is, the highway to recovery is very long, lasting weeks to months. Since it takes quite some time for inflammation in the eye to clear up, the physician will want to follow the individual frequently to ensure the infection is getting better.
The key to full recovery is to contact an eye specialist as quickly as possible when symptoms first develop. The earlier the treatment is started the better the prognosis is.
